LISA... is a parent support and lobby group, for parents and families with a family member having an intellectual or multiple disability, and living in a supported accommodation group home in the State of Victoria, Australia.

The NDIS “Quality and Safeguarding Framework” is, in principle, similar to Victoria’s disability policies and standards by the Department of Health & Human Services. They are both intended to set the standard of care and support for people with disabilities.

No matter how good intentions are, the implementation of such policies and standards at the service point for people with intellectual and multiple disabilities is totally dependent on support service management having the ability and integrity to consistently set, monitor and maintain direct care staff work value expectations that they shall consistently provide support services within care policies, standards and values, and within their job descriptions.

Overall there is far too much mindercare in services such as group homes and day services, where service level, quality and staff integrity are difficult to monitor and evaluate, with most clients having little ability to report questionable activities, and are mostly not believed anyway. And, stakeholders are often very actively discouraged from any form of service evaluation, and are made feel unwelcome to attend service facilities – most especially by government direct services such as DHHS in Victoria. Some of the findings of the KPMG were - https://0j.b5z.net/i/u/10196230/f/extracts_from_kpmg_rreview_of_dhhs.das.pdf

Many group home direct care staff see their role as just administration, domestic duties and client personal care. They see all ‘active support’ as the responsibility of day services. Whereas, many day service staff see their role as little more than a minder service. Between the two, clients fall into total mindercare. And, with the predicted extreme shortage of direct care staff for the full roll-out of the NDIS, the potential of questionable care and support is compounded.

With the NDIS policy and practice focused mainly on participants with low support needs and individualised digital/tick-the-box support, those with high support needs will get little of what they really need – consistent analogue interaction, engagement and skill development within the main support service funding avenues of their NDIS plan. That they are not left doing little but sit or wander aimlessly for most of their day, every day.

There are two basic costs associated with living in a group home. The ‘support service cost’, and the ‘residential charge’.

The support service cost, is the cost of support staff and associated overheads. This can be in the form of block funding (government funding direct to the service provider), or an ISP (Individual Support Package) per resident - paid to the resident or their administrator.

The residential charge is the cost of day to day living - this generally includes, rent, housekeeping and personal expenditure, but can include other items. Otherwise, other items such as manchester, whitegoods, clothing, transport, etc, is paid directly by the resident or their administrator.

The Department of Human Services in Victoria (the department) has for years funded the residents of its group homes with block support service funding per resident, with an expectation each resident shall pay their actual daily living cost for rent, housekeeping and personal expenditure – about 55% of the DSP (Disability Support Pension).

In 2013, the Minister for Community Services and Reform attempted to change this 55%, to 75% with no cost justification – just because the legislation says service providers can charge up to this figure, plus 100% of CRA (Commonwealth Rent Assistance).

Residents of department managed group homes in Victoria beat the Minister’s attempt to achieve this. Not only was the move from a residential charge of 55% of DSP to 75% of DSP beaten, but the department gave their residents a sweetener in the form of free manchester and whitegoods for handing over the full CRA they received from Centrelink when the department bundled the rent and housekeeping components – to be called a residential charge..

Yet most residents of non-government group homes, pay the legislated residential charge of 75% of the DSP, and 100% of the CRA, with no justification – no breakdown of these charges.

It is well known, the department fails to fully fund non-government services for their support service costs, as the department does its own group home services.

Non-government, not for profit, service providers, often known as CSOs (Community Service Organisations), therefore, have to make up the short fall by charging their residents more, fund raising or using less support staff, or a combination thereof.

The cost difference between DHS and CSO managed group homes creates a ‘them and us’ situation - a discriminatory situation which should not be. There should be no basic cost difference between the residents of different service providers. The only cost difference between residents might be slight differences in daily living needs, such as food, clothing, incontenence aids, etc.

Those with so little in their lives per se, will suffer the indignity of living hand to mouth, with any money they may have saved in the past, having to be spent before being entitled to hardship.

The NDIS (National Disability Insurance Scheme) is intended to provide just support service costs of the group home, in the form of an ISP. Residential charges will remain as determined by the service provider. However, some of that which make up the 75% of DSP, may be negotiable within the NDIS service needs assessment..

The Productivity Commission’s intention that consumers will drive service quality by putting the support service funding in their pocket, rather than the pocket of service providers, is little more than smoke and mirrors - as most group home residents do not move easily, and there is unlikely to be sufficient service choice in the foreseeable future.

As regards the support service fee, it should be established if this includes "Active Support". If so, to what degree/extent..

If the support service fee is in an ISP format, the support service will be calculated on the basis of the current ‘unit price’. This is the hourly rate for support staff, plus overheads. The current, basic, DHS unit price/cost is $40.79 per hour. Whereas, the NDIS unit price/cost is around $52 per hour. ISP Handbook

It is important consumers take the stand, that they should not be expected to contribute towards the support service costs

The VPSC (the Victorian Public Sector Commission) is conducting anindependent review of residential chargesin group homes operated by both the Department of Human Services and not for profit community sector organisations (CSOs). The VPSC findings are due at the end of the year (2014). This should reveal some quite unjust anomalies but we feel will do little to stem the movement down the poverty road for many group home residents throughoutVictoria.

Note: We acknowledge the above overview is not comprehensive, as there are so many parameters within this complex subject. The overview is intended to provide food for thought, and help encourage investigation/clarification of the many anomalies. Please advise us of your concerns and findings, and/or comment anonymously on the forum page.

Keep the Bloated Bureaucratic Bungling, say HACSU“We are so busy with the paperwork about care, to do the care!"
“Reality and choice versus ideology and confusion!”
"Layers of management that don't!”

HACSU says the Sandhurst Centre, Bendigo, is one of the last congregate care facilities in Victoria, and is scheduled to close in 2016.

They say the Napthine Government is most likely intending to have the subsequent group home services provided by non-government service providers

This union claims CSOs are struggling to properly fund equitable pay and conditions as the public sector. They claim lower wages and conditions equals less ability to attract, retain and recruit skilled direct care staff, and the NDIA market-rate for wages and conditions is poor.

HACSU anticipate, if the present government of Victoria is re-elected, they will follow WA and NSW, and move all public sector disability services to the CSOs or profit providers.

This union says the success of the NDIS, and disability services, will depend on having a trained and skilled workforce who are committed to the work. Without commensurate pay and conditions, this will not occur!

LISA Comment: The above HACSU, Health and Community Services Union, vision is an affront to not-for-profit CSOs, Community Service Organisations.

These comments suggest the union’s main concern is retaining and supporting its members, in contrast to level, quality and amount of services for people with disabilities and their families.

Whilst so many parents have to provide support, well into their senior years, for their adult family member with disabilities, the Department of Human Services (DHS/the department) squanders government resources by failing to, and being unable to properly manage its services and resources.

As a consequence, the department fails to fully fund CSOs with support service funding, as they do their own services. CSOs have to, therefore, charge their residents more, fund raise or use less support staff. Or a combination thereof.

Since time immemorial, the department has used its despotic powers to totally control every aspect of services funded mainly from state government block funding for people with limited capacity and so little in their lives.

The department’s DSR (Disability Support Register) totally restricts the reasonable human right of choice and control for those living in, or seeking to live in a group home/shared supported accommodation (SSA). We trust the NDIS will eventually release vulnerable people and their families from the despotic clutches of government services, for them to have real choice and control.

Residents of SSAs are currently unable to choose their service provider, the department denies its residents real residential tenancy rights, is in totally denial in respect to service level and quality complaints and is unable to properly and consistently manage it services to ensure they are fully and consistently within their extensive and comprehensive care policies, standards and values.

The union’s quest is to retain the department as a service provider, as the department is a soft target to fund their membership with little or no justification this translates into consistent and meaningful quality of care for the residents of department group homes.

Layers of bloated and dysfunctional public service administration within the department is illustrated by the level of government funding they give themselves, versus the level of government funding they provide to non-government service providers who provide similar services for people with disabilities throughout the state.

State government group homes receive, on average, $128,000 per resident, per year. Whereas, non-government group homes receive just $76,000 per resident, per year.

The department has to spend-up-big to compensate for its reactive management's bureaucratic bungling throughout... Its reactive rather than proactive management buys, rather than properly manages its way!

The department spends-up-big on its massive range of publications - care policies, standards and values. Incentive is, however, quite limited when it comes to the consistent implementation of the direction, intention and spirit of these care policies, standards and values for whom they are intended - people with disabilities who should be at the centre of service provision, and without whom there would be no DHS.

Successive state governments fund the department, but have little or no control over its systemic operations, or its bureaucratic field-day with public money, whilst tight expectations are set on the short-changed non-government, not for profit, CSO service providers.

If the residents of current block funded group homes were, at the stroke of a pen, given their block support service funding in an ISP (Individual Service Package) format, as well as their human right of real residential tenancy rights, they could, at will, (a) move service providers or, (b) as a group, choose their service provider and directly negotiate their service contract. This would be real choice and control!

The Disability Worker Exclusion Scheme is a new initiative from the Victorian Government designed to further protect the safety and wellbeing of Victorians living in disability group homes.

Consistent with feedback from the disability sector and key stakeholders, the Disability Worker Exclusion Scheme will require disability service providers to conduct an additional pre-employment check under the scheme, prior to making an offer of employment.

The Disability Worker Exclusion Scheme will be implemented in collaboration with disability service providers so that the scheme can commence on 29 September this year (2014).

The Disability Worker Exclusion Scheme strengthens existing pre-employment screening processes to better protect people living in disability group homes.

Both government and non-government disability service providers will be covered by the scheme.

People who pose a proven risk to the health, safety or welfare of people with a disability living in group homes will be listed on the Disability Worker Exclusion Scheme.

LISA Comment: The Department of Human Services, Victoria (the department), is under political pressure to rush this very legalistic and moralistic scheme into operation. CSOs have major concerns it has not been well thought through!

The department has certainly not considered the front-end of this scheme, nor of its own major problems in respect to the range of questionable activities of many of its own staff, for which its management, at all levels, is unable / unwilling to properly address.

Clearly identifying the perpetrator of questionable activities in the field of disability services can be a complex, moral and very personal problem for which other staff feel the need to keep well clear.

This is especially so in department managed services, as those reporting risk exposure by, and the persecution of management who want to send the message to, ‘take the pay and look the other way’, as we don’t want the messy problem of dealing with questionable staff.

A worker is considered to be bullied if an individual, group, supervisor or manager repeatedly behave unreasonably towards them, and such behaviour creates a risk to their wellbeing.

Whereas, bullying can be a work avoidance tool by those workers who claim being bullied by managers or supervisors who attempt to set, monitor and maintain reasonable work value expectations.

The expectation of reasonable work performance should not be deemed bullying, so long as such has been by reasonable management standards. However, management standards are like hen’s teeth in the public service, where being a group home house supervisor is often not an enviable task.

Department managed group homes also suffer from ‘house politics’. These being almost solely as a result of staff lore, resulting from the house supervisor being unable to set, monitor and maintain staff work value expectation to achieve consistent service level and quality within departmental care policies, standards and values, without being bullied.

Direct care staff who are keen to provide their residents with meaningful and consistent quality of life care, strive to have the home be a mentally healthy workplace.

The Department of Human Services is determined to stay in business, despite all services are intended to be under federal control and standards. Rather than just provide funding to the NDIA, they are providing their services as part of the state's contribution to the NDIS under an 'in kind' arangement.

With their feet now firmly under the NDIS table in the Barwon region, they clearly intend to become a service provider of choice within the NDIS, across the state. Naturally, they will have HACSU support to continue to provide services with a significant disconnect between service intent and service delivery - as a direct result of the failure of all levels of their public service management, above house supervisor, to ensure there is no disconnect between service intent and service delivery.

Existing DHS services being provided to the NDIA under this ‘in-kind’ arrangement are:

DHS GROUP HOME CHARGES/COSTS(DRAFT at 1 Feb 2014)“Items and amounts are often a matter of conjecture”

The charges for residents in DHS group homes have (prior to early 2014), generally, been quite standard for years. Administrators pay a monthly amount (John pays $870pm) to the Client's Trust Fund with State Trustees, and State Trustees pay the DHS from the Trust Fund three components (as per attachment): Rent ($231.17pm),
Housekeeping ($458.84pm) and Personal Expenditure ($168pm).

 Rent is standard for everyone.

 Housekeeping varies a bit from house to house. Housekeeping includes, Food, Utilities and Kitchen Items such as cups, plates, cutlery, etc, etc.

 Personal Expenditure covers the person’s social activities as well as their
toiletries.

As well as paying the Trust Fund Fee, administrators pay for such items as those listed below:-

The DSP is, in total, $1,660pm (without CRA - not everyone gets the CRA). So the balance for John, without the CRA, is $1660pm less $870pm (Trust fund payment) = $790 less Day Services ($300pm), Private Health Insurance ($130pm), Manchester ($30pm) Clothes ($50pm), Dental Charges ($15pm), Medication ($40pm), Masseur
(76pm), Lunches whilst out with his family ($50pm, and any shared charges (as mentioned above) ($50pm) = $49pm disposable income.If, however, the resident is receiving some CRA ($80pm) and the Mobility Allowance ($174pm) (not used for the purpose intended) then their disposable income will be $303pm.

NOTE: Many figures are considered to be a reasonable estimate.

-----------------------------------------------------------------------------------------------What will happen when the B&L starts in Mar/Apr 2014?

The Rent and Housekeeping will remain about the same, but the two will be combined (bundled) – just a little adjustment for cost of living increases.The main reason for combining these two components is, through an agreement
between the State Government and Centrelink, all DHS residents will be eligible for the full CRA ($270pm.

In exchange for the full CRA being handed over to DHS, DHS has agreed to pay all manchester (bed linen, towels etc), and domestic equipment requiring repair orreplacement, such as toasters, dishwashers, washing machines, etc. Leaving the resident (administrator) with just the combined rent and housekeeping, to be called "B&L", clothes, medication, personal expenditure, and other personal items Personal Expenditure remains as is.

Under "B&L" the resident will be financially better off, but will lose "Choice and Control", as the department will now have control over most things they have agreed to fund from the CRA.

We do, however, have concerns there will be significant amount left from the CRA to go into state coffers.

DHS state the service components to be funded by the CRA are:-

utilities, communications including telephone, communal furnishings and whitegoods, food, general household consumables, household equipment and utensils, bedding and linen and repair or replacement of the relevant listed items as required.

Whereas, utilities, communications, including telephone, food, household consumables, household equipment and utensils is, and will be covered from housekeeping. Just bedding, linen, communal furnishings, whitegoods and repair or replacement of the relevant listed items are required to be funded from the CRA of $270pm from each resident.

In conclusion, we estimate just $100 of the CRA would be required by the DHS to fund the above listed CRA funded items. This leave a $170pm profit for the state government from each of the 2,300 residents throughout the state. This being over $4.6 million in total profit for the state government.

The LISA Team invites you to use this page to commenton any aspect of disability and/or our website contentUse any name you wish ...----------------------------------------------------------------------------------------------------------------------------

Messages for service provision under DisabilityCare
Australia, which have arisen from the consultationsof the NDIS Workforce Ready Project – June 2013

People with disability and their families should be able to consistently receive high quality and innovative supports that enable them to maximise independent lifestyles and their full inclusion in the mainstream community.

People with disability and their families should exercise the maximum choice and control possible in the planning and delivery of their supports, including decisions relating to the selection of people who will be responsible for providing their support services.

People with disability and their families vary in their preparedness and capacity to direct and monitor their own services, as does their degree of vulnerability to neglect and abuse (malpractice), which needs to be taken into account when recruiting and monitoring direct support staff.

There is a need to safeguard the best interests of people with disability and their families by having in place mechanism to ensure only those persons who are ‘good citizens’ work in the disability sector, and to prevent malpractice.

There is need to have established systems that can respond to allegations and established situations of malpractice (especially with respect to preventing the vocational mobility of those who have an established record of malpractice).

There is a need to attract and retain good people, who are ‘right for the job’; that is people who listen to, serve, and support people with disability to achieve their goals.

There is a need to create career paths for those who seek to work in support of people with disability in the longer term.

There is a need to provide a system that accommodates those who might only work part–time, or for short periods in the disability sector.

There is a need to provide a system that can accommodate family members who provide paid care, and others in the community who work as volunteers.

The tasks asked of the disability sector workforce vary greatly in their complexity, and consequently so do the levels of experience, skills and knowledge required to perform these tasks; from relatively simple domestic assistance to work involving health care, assistance with medication, and psycho-social educational programmes.

Values and attitudes are considered to be the basis for an effective workforce. Some of the core values to be identified for the workforce included ‘human rights’ (as referenced in the United Nations Convention on the Rights of Persons with Disability, 2006), and fundamental principles such as the exercise of choice, self-determination, and community inclusion.

Experience and skills acquired in a variety of ways need to be recognised; including experience and skills developed through personal experience (e.g., linguistic or cultural competencies) practical work (having previously supported a person with disability, including a relative or friend) and informal training (self-initiated or provided by an employer, but not necessarily accredited under the Australian Qualifications Framework or other such scheme).

Knowledge gained through formal (accredited) educational programmes need to be recognised, and people should be encouraged and rewarded for having pursued formal education commensurate with the needs of their clients and their personal career objectives.

On-going and in-service education and training are vital to maintain currency of knowledge and skills.

Specialist and advanced knowledge and skills need to be recognised.

Some areas of practice should require formal accreditation.

Issues of accreditation and remuneration need to be considered together. That is, industrial agreements will need to recognise those who attain higher levels of accreditation with higher levels of remuneration. Such an integrated system will be important to both recognise and encourage people to develop their skills and knowledge, and in turn raise standards of practice.

Strategies are needed to ensure consistency in the quality of training and assessment , and in the outcomes to these courses, including maintaining consistency and standards in AQF accredited programmes, where currently there is evidence of diversity in quality of outcome despite standardisation ofunits of competency.

Formal recognition of people who are ‘right for the job’ needs to be introduced gradually; to ensure that we do not lose the many good people that are currently working in the sector Summary of Key Findings including paid family carers and those in the community who work as volunteers in the disability sector; and to ensure that any such system does not impede others coming to the sector – especially those who might have experienced difficulties or disadvantage in education, those from non-English speaking backgrounds, and those with a disability themselves.

The introduction of any such scheme needs to take into account workforce shortages in regional, rural and remote areas, and work towards supporting those who currently are, or who could potentially be, ‘right for the job’ to attain the necessary accreditation.

Formal recognition should be structured in a way that both enables people with disability to recognise and select from an accredited workforce,and which recognises and rewards (encourages) those who seek a career path in the sector.

Any scheme to formally recognise the disability sector workforce needs to be established in a way that emphasises collaboration between people with disability and their families, the direct support workforce, service providers and government.

In the context of Responsive Regulatory Theory, there is an emerging consensus that the current situation, in which the market place generally sets its own standards, with possibly some minimal oversight by an employing agency (e.g., police checks, reference checks, and supervision), and no nationally accepted industry bench-mark recognition being required, is not satisfactory.

Market-based regulation might provide for those situations where people with disability and their families retain staff for basic domestic duties (e.g., cleaning, cooking, shopping, gardening) that they themselves direct. However, this is not considered sufficient to provide the safeguards needed for more complex areas of practice, or where people with disability are limited in their ability to exercise higher levels of direction and self-advocacy.

Bearing in mind the need to leverage social capital and good will in the sector, as well as the current complexities of the workforce, there is general endorsement of the need to initially develop at minimum a voluntary accreditation scheme. Such a scheme would provide basic safeguards and recognition of people who were ‘right for the job’.

There is support for the development of a more formal register of people who would then be recognised as ‘right for the job’, especially for those who seek to practice in more complex areas of work, or to support people who are limited in their capacity to self-direct or self-advocate, and are consequently recognised as particularly vulnerable to neglect, abuse or malpractice.

Any such compulsory register would need to encompass features to accommodate the varying needs of people with disability and their families (including their varying needs for protection against malpractice), and the
varying complexities of the tasks involved in direct support activities.

A national approach to any such scheme is considered important. A national approach would ensure continuity of standards and procedures across states and territories. It is also noted that the direct support workforce includes a cohort of people who are mobile across states and territories and that it is in the best interests of both workers and people with disability that the scheme is national.

Local administration of any scheme is considered important to its effective operations and responsiveness to the needs of both people with disability and the workforce.

The administrative structure of any such scheme would need to encompass participation by people with disability and their families, direct support workers, service providers and government.

The establishment of any such administrative structure would need to reflect it having status (authority) in the community.

The establishment of any such scheme would need to ensure its independence from other existing stakeholder groups (i.e., being constituted in a way that eliminated any potential conflicts of interest).

Such a scheme should concern its self with both practical skills and knowledge of the workforce, as well as setting standards of ethical conduct.

The cost of establishing any such scheme would need to be met by Government.

The cost of maintaining any such scheme might in part be supported by registration fees, but these fees would need to be calculated taking into account the current pay structures in the sector, as well as the preponderance of part-time workers, family careers and volunteers, together with the varying degrees of complexity of task for which people were seeking accreditation to perform.

Comments from a staff team who ran a DHS
group home like it was their own business

Practical Active Support:

Active Support is an approach aimed at supporting people with disabilities to become more involved in the day-to-day activities within their home.

A number of DHS houses have had staff undertake training, and piloted the approach. A staff member from one such group home, back in 2005, made the following observations about the implementation of the approach.

Residents:

The residents are all interested in the activities and seem to really enjoy the positive nature of these interactions. Boredom has been greatly reduced and there has been a decrease in challenging behaviours. The environment in the house is happier, with more opportunities for residents and staff to engage in positive activities and interactions. In fact, one of the residents now frequently congratulates himself with phrases such as "Good work" and ‘Good cook’.

Staff:

It quickly became obvious that this initiative would be very much "staff driven" and that the success (or lack of) would be directly influenced by the imagination, enthusiasm and determination of staff to put in the thought and effort required.

It was necessary for us to adjust our way of doing and thinking to accommodate the concepts of active support. This is an ongoing process, but we have gradually ‘grown’ into these new habits and this is happening at an ever-expanding rate.

The most significant change for staff has been in our perceptions of how we see the people we work with. We are now definitely more "ability" orientated in the way we look at the residents.

Instead of looking at the challenges that some people's disabilities present, we are now looking at what each person may be capable of, and presenting the activity in a way that is most likely to succeed and be enjoyable.

We have also greatly reduced the amount of tasks that we automatically carried out on the resident's behalf. Instead, it has virtually become automatic to look at how we can involve any or all of the people living in the house”